Pediatric Neurosurgery

Birmingham, AL, United States

Pediatric Neurosurgery

Birmingham, AL, United States
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Dr. Clarence S. Greene, Jr., Director of Pediatric Neurosurgery Education, LSU Health School of Medicine, has joined The Expert Network©, an invitation-only service for distinguished professionals. Dr. Greene has been chosen as a Distinguished Doctor™ based on peer reviews and ratings, numerous recognitions, and accomplishments achieved throughout his career. Dr. Greene outshines others in his field due to his extensive educational background, numerous awards and recognitions, and career longevity. After completing his undergraduate degree at the University of Pennsylvania in 1971, he attended Howard University in Washington, D.C. and graduated with his M.D. in 1974. From there, he undertook his internship at Howard University Hospital followed by a residency at Harvard's Brigham and Women’s Hospital & Children’s Hospital in Boston. With over 35 years dedicated to medicine, Dr. Greene brings a wealth of knowledge to his industry, and in particular, to his area of expertise, pediatric neurosurgery. When asked why he decided to pursue a career in this specialty, Dr. Greene said: "My father was a very successful surgeon, so from a very young age, I was told that I was going to be just like my dad. Most of us in my peer group went to medical school because that was the business our families were in. I carefully considered my options as I went through school and decided neurosurgery was fascinating, but subconsciously I think the decision was already made for me." Dr. Greene currently serves a clinical professor of neurosurgery and director of pediatric neurosurgery education at LSU Health School of Medicine in New Orleans, Louisiana where he specializes in matters such as brain tumor, craniosynostosis, Hydrocephalus, neuroendoscopy, spina bifida, and spinal cord surgery. Dr. Greene is a member of the American Society for Pediatric Neurosurgery (ASPN) and has continually been voted as one of the nation’s top doctors since 2012. From intricate surgeries to minimally invasive procedures, Dr. Greene treats each patient with the highest quality of individualized care and compassion. He is experienced in treating conditions of the brain and nervous system, and meninges, as well as issues of the skull, pituitary gland, spinal cord, vertebral column, cranial nerves, and spinal nerves, and is board certified in both neurological surgery and pediatric neurological surgery. As a thought-leader in his specialty, Dr. Greene keeps his finger on the pulse of developments in the field of pediatric neurosurgery to ensure the most up to date treatments and computer generated navigational equipment to map tumors and execute procedures for his patients. Discussing the evolution of procedures in the field, he says: "Endoscopic procedures in the brain for hydrocephalus and tumors has become more popular. We utilize these instruments and techniques in correcting premature closure of the cranial sutures or craniosynostosis as well, which is a much less invasive way to manage these conditions." For more information, visit Dr. Greene's profile on the Expert Network here:,-md/1f23263a29d73d76 The Expert Network© has written this news release with approval and/or contributions from Dr. Clarence S. Greene, Jr. The Expert Network© is an invitation-only reputation management service that is dedicated to helping professionals stand out, network, and gain a competitive edge. The Expert Network selects a limited number of professionals based on their individual recognitions and history of personal excellence.

News Article | April 17, 2017

Chicago...Using state-of-the-art gene editing technology, scientists from Ann & Robert H. Lurie Children's Hospital of Chicago have discovered a promising target to treat atypical teratoid/rhabdoid tumor (AT/RT) - a highly aggressive and therapy resistant brain tumor that mostly occurs in infants. They found that these tumors' growth and tendency to metastasize are regulated by a protein kinase called Polo-like kinase 4 (PLK4), which is increased in AT/RT. They also have demonstrated that an experimental drug, a PLK4 inhibitor, stopped tumor growth. Findings were published in Pediatric Blood & Cancer. "This is the first time that PLK4 has been described as a therapeutic target for brain tumors or in pediatric cancer," said lead author Simone T. Sredni, MD, PhD, Associate Professor of Pediatric Neurosurgery at Northwestern University Feinberg School of Medicine and cancer researcher at the Stanley Manne Children's Research Institute at Lurie Children's. Sredni and team were able to identify PLK4 as a potential target for treatment by using a novel gene editing technology called CRISPR/Cas9. It allowed them to mutate individual kinase genes - key regulators of cell function - in order to reveal the kinase that most significantly affected tumor cell growth. Then they targeted that kinase with an available kinase inhibitor, currently being tested for breast cancer. Sredni and colleagues also found that the PLK4 inhibitor (CFI-400945) was safe for normal tissue, while attacking the cancer cells. "The drug we used to inhibit PLK4 significantly impaired tumor proliferation, survival, invasion and migration, while sparing normal cells," said Sredni. "This may be a paradigm shift for the treatment of AT/RT and possibly other pediatric brain tumors". The scientists tested the safety of the drug by exposing zebrafish larvae to extremely high doses of the drug for extended periods of time. They observed that the drug did not affect the fish development, implying that it may be safe to be used in the pediatric population. "This could also be an opportunity for a precision medicine approach as we can stratify patients who are eligible for treatment with the drug by investigating the level of PLK4 expressed in their tumors," said Sredni. The group is currently testing the drug in animal models of AT/RT, as well as other types of brain tumors. Sredni envisions a Phase I clinical trial soon. This study was funded by the Rally Foundation for Childhood Cancer Research in memory of Hailey Trainer, Voices Against Brain Cancer Foundation and Lurie Children's Hospital Faculty Practice Plan Development Funding. Sredni is part of the research group of Tadanori Tomita, MD, Division Head of Pediatric Neurosurgery and Medical Director of the Falk Brain Tumor Center at Lurie Children's. Tomita also is Yeager Professor of Pediatric Neurosurgery and Professor of Neurological Surgery at Northwestern University Feinberg School of Medicine. Research at Ann & Robert H. Lurie Children's Hospital of Chicago is conducted through the Stanley Manne Children's Research Institute. The Manne Research Institute is focused on improving child health, transforming pediatric medicine and ensuring healthier futures through the relentless pursuit of knowledge. Lurie Children's is ranked as one of the nation's top children's hospitals in the U.S.News & World Report. It is the pediatric training ground for Northwestern University Feinberg School of Medicine. Last year, the hospital served more than 198,000 children from 50 states and 51 countries.

Baumgartner J.E.,Florida Hospital | Blount J.P.,University of Alabama at Birmingham | Blauwblomme T.,Pediatric Neurosurgery | Blauwblomme T.,University of Paris Descartes | Chandra P.S.,All India Institute of Medical Sciences
Epilepsia | Year: 2017

Hemispherectomy is a complex multistep procedure with a steep learning curve. Several surgical approaches have been developed, but each requires considerable practice to master. Four experienced pediatric neurosurgeons, who participated in the 2014 Gothenburg Pediatric Epilepsy Surgery Meeting, provided succinct technical summaries of four hemispherectomy approaches: modified functional hemispherectomy, peri-insular hemispherotomy, parasagittal hemispherotomy, and endoscopic-assisted hemispherotomy. No clinical or outcome data are included. Our intention is to reduce the slope and length of the learning curve for surgeons and to improve the understanding of the technical details of hemispherectomy surgery by nonsurgeonmembers of epilepsy teams. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy

Griessenauer C.J.,University of Alabama at Birmingham | Rizk E.,Pediatric Neurosurgery | Miller J.H.,University of Alabama at Birmingham | Hendrix P.,University of Alabama at Birmingham | And 4 more authors.
Journal of Neurosurgery: Pediatrics | Year: 2014

Object. Tectal plate gliomas are generally low-grade astrocytomas with favorable prognosis, and observation of the lesion and management of hydrocephalus remain the mainstay of treatment. Methods. A cohort of patients with tectal plate gliomas at 2 academic institutions was retrospectively reviewed. Results. Forty-four patients with a mean age of 10.2 years who harbored tectal plate gliomas were included in the study. The mean clinical and radiological follow-up was 7.6 ± 3.3 years (median 7.9 years, range 1.5-14.7 years) and 6.5 ± 3.1 years (median 6.5 years, range 1.1-14.7 years), respectively. The most frequent intervention was CSF diversion (81.8% of patients) followed by biopsy (11.4%), radiotherapy (4.5%), chemotherapy (4.5%), and resection (2.3%). On MR imaging tectal plate gliomas most commonly showed T1-weighted isointensity (71.4%), T2-weighted hyperintensity (88.1%), and rarely enhanced (19%). The initial mean volume was 1.6 ± 2.2 cm3 and it increased to 2.0 ± 4.4 cm3 (p = 0.628) at the last follow-up. Frontal and occipital horn ratio (FOHR) and third ventricular width statistically decreased over time (p < 0.001 and p < 0.05, respectively). Conclusions. The authors' results support existing evidence that tectal plate gliomas frequently follow a benign clinical and radiographic course and rarely require any intervention beyond management of associated hydrocephalus. ©AANS, 2014.

Davis M.C.,University of Alabama at Birmingham | Griessenauer C.J.,University of Alabama at Birmingham | Bosmia A.N.,St. George's University | Tubbs R.S.,St. George's University | And 2 more authors.
Clinical Anatomy | Year: 2014

The giants of medicine and anatomy have each left their mark on the history of the cranial nerves, and much of the history of anatomic study can be viewed through the lens of how the cranial nerves were identified and named. A comprehensive literature review on the classification of the cranial names was performed. The identification of the cranial nerves began with Galen in the 2nd century AD and evolved up through the mid-20th century. In 1778, Samuel Sömmerring, a German anatomist, classified the 12 cranial nerves as we recognize them today. This review expands on the excellent investigations of Flamm, Shaw, and Simon et al., with discussion of the historical identification as well as the process of naming the human cranial nerves. Clin. Anat. 27:14-19, 2014. © 2013 Wiley Periodicals.

Mortazavi M.M.,University of Washington | Verma K.,Pediatric Neurosurgery | Harmon O.A.,Pediatric Neurosurgery | Griessenauer C.J.,Pediatric Neurosurgery | And 3 more authors.
Clinical Anatomy | Year: 2015

Spinal cord injury is a highly prevalent condition associated with significant morbidity and mortality. The pathophysiology underlying it is extraordinarily complex and still not completely understood. We performed a comprehensive literature review of the pathophysiologic processes underlying spinal cord injury. The mechanisms underlying primary and secondary spinal cord injury are distinguished based on a number of factors and include the initial mechanical injury force, the vascular supply of the spinal cord which is associated with spinal cord perfusion, spinal cord autoregulation, and post-traumatic ischemia, and a complex inflammatory cascade involving local and infiltrating immunomodulating cells. This review illustrates the current literature regarding the pathophysiology behind spinal cord injury and outlines potential therapeutic options for reversing these mechanisms. Clin. Anat. 28:27-36, 2015. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Mortazavi M.M.,University of Washington | Harmon O.A.,Pediatric Neurosurgery | Adeeb N.,Pediatric Neurosurgery | Deep A.,Pediatric Neurosurgery | And 3 more authors.
Clinical Anatomy | Year: 2015

Over time, various treatment modalities for spinal cord injury have been trialed, including pharmacological and nonpharmacological methods. Among these, replacement of the injured neural and paraneural tissues via cellular transplantation of neural and mesenchymal stem cells has been the most attractive. Extensive experimental studies have been done to identify the safety and effectiveness of this transplantation in animal and human models. Herein, we review the literature for studies conducted, with a focus on the human-related studies, recruitment, isolation, and transplantation, of these multipotent stem cells, and associated outcomes. Clin. Anat. 28:37-44, 2015. © 2014 Wiley Periodicals, Inc. © 2014 Wiley Periodicals, Inc.

Frassanito P.,Pediatric Neurosurgery | Frassanito P.,Pediatric Neurosurgery Unit | Massimi L.,Pediatric Neurosurgery | Caldarelli M.,Pediatric Neurosurgery | And 2 more authors.
Acta Neurochirurgica | Year: 2012

Background Decompressive craniectomy is an effective treatment option in case of refractory intracranial hypertension after severe head injury. The incidence of complications following cranial repair after decompressive craniectomy for traumatic brain injury is not negligible, particularly in infants and young toddlers. However, only a few dedicated papers can be found in the literature. Method We describe the complications observed in two boys and one girl under 1 year of age that were treated in the last decade by hemicranial decompressive craniotomy and enlarging hemispheric duraplasty, and subsequent cranial repair by means of autologous bone-flap replacement. Findings Despite good clinical and neurological outcome, the postoperative clinical course was complicated in all cases by early or late evidence of subdural fluid collections associated to the occurrence of hydrocephalus and causing recurrent dislocation and progressive resorption of the autologous bone flap. Conclusions Infants less than 1 year old, undergoing decompressive craniectomy after traumatic brain injury, experience a high rate of complications following subsequent cranial repair. Subdural collections and resorption of the autologous bone flap are to be considered as extremely common complications. © Springer-Verlag 2012.

News Article | February 20, 2017

When a child suffers a mild head injury, doctors have well-established protocols for determining whether that child should have a computed tomography (CT) scan to assess the damage. Most children with mild traumatic brain injury have normal CT scans—a scenario referred to as a concussion. If a CT scan is abnormal, however, a child’s condition is at higher risk of deteriorating, requiring monitoring in a hospital. But there is little consensus about how closely such children should be monitored. Some children recover well, while others experience a neurological decline and need surgery to relieve brain swelling. Pediatric neurosurgeons have developed a risk scoring system intended to help determine whether a child with mild traumatic brain injury and an abnormal CT scan can be monitored safely in a general hospital ward or requires the increased surveillance of an intensive care unit. “We want to care for these children in the safest way possible and at the same time not place kids unnecessarily in ICUs if they don’t need that level of care,” says senior author David D. Limbrick, professor of neurological surgery and of pediatrics and director of the Division of Pediatric Neurosurgery at Washington University in St. Louis. “We have identified factors that indicate which of these patients are likely to experience neurological decline and require surgery and which are not. This information can help health-care providers decide where to place these children when they are admitted into the hospital.” For the study in JAMA Pediatrics, researchers plumbed data from more than 40,000 children evaluated from 2004 to 2006 at 25 North American hospital emergency departments. The information originally comes from a study conducted by the Pediatric Emergency Care Applied Research Network, which established the standard framework for deciding whether a child with a mild head injury should have a head CT scan. Researchers returned to this data set for guidance on how to handle the subset of children who receive CT scans and are shown to have abnormal findings on the scans. Of the 40,000 children enrolled in the study, 15,000 had CT scans following mild traumatic brain injury. Of these, 839 patients showed abnormalities on the CT scan, such as a brain bleed. These types of injuries are serious enough that some children will experience a neurological decline and need surgery to relieve swelling or pressure on the brain. In the United States, traumatic brain injury leads to almost 600,000 emergency room visits annually. Of new pediatric brain injury cases, more than 90 percent are determined to be mild. About one-third of the 50,000 to 60,000 children hospitalized each year due to head trauma have mild traumatic brain injury. Based on an analysis of the injuries these patients suffered and how they recovered, the investigators developed a risk score ranging from zero to 24 points, called the Children’s Intracranial Injury Decision Aid score. Higher scores indicate the patient is at higher risk of neurological decline and should receive increased monitoring. Lower scores mean a patient is at lower risk of neurological decline. A score of zero indicates the child is at very low risk. The chance that such a child would go on to experience a neurological decline that requires surgery is less than 1.5 percent, according to the analysis. As a general rule, children with scores of less than three points can safely be admitted to a general ward. Patients with higher scores should receive increased surveillance up to and including that provided in an ICU. “There is a lot of variability in how these patients are managed,” says first author Jacob K. Greenberg, a neurosurgery resident. “When we looked back at the data, we saw situations where children were perhaps put in the ICU but didn’t need to be there. And conversely, some patients were placed in a general ward when their risk factors suggested they needed closer monitoring. We are trying to develop this evidence-based tool to help guide and standardize this decision-making process.” The score is determined by four factors that the researchers found most predictive of patient outcomes. One factor is called the Glasgow Coma Scale (GCS), which is used to measure how alert and responsive a patient is after a blow to the head. Fifteen is the highest and best GCS score, meaning the patient can open his or her eyes spontaneously, follow commands to move different body parts and answer questions clearly and appropriately. While the GCS is based on a doctor’s interaction with a patient, the other three factors are determined based on an analysis of a CT scan. The biggest risk factors seen in a CT image are a depressed skull fracture and what is referred to as a midline shift, when the symmetrical structures of the brain are pushed off-center. The final risk factor is an epidural hematoma—a blood clot between the outer layer of the brain’s protective covering and the inside of the skull. Patients with mild traumatic brain injury who show these features on a CT scan and also have a lower GCS score are at high risk of experiencing a neurological decline and, according to the researchers, should be cared for in an ICU. “There are a variety of potential harms associated with sending a patient to an inappropriate location,” Greenberg says. “I think the most important is that if you send a child who needs the ICU into a general hospital ward, you risk missing a potential decline that could have been caught earlier. If the patient experiences new weakness or worsening mental status, for example, the goal is to intervene as quickly as possible to avoid permanent disability or even death. “On the other hand, if you send too many patients to the ICU, there are significant financial costs there, as well as emotional costs for the family,” he says. “Another concern is the limited space available in pediatric ICUs. Having children in the ICU who don’t need to be there is taking beds away from other patients who do need those resources.”

News Article | November 2, 2016

WASHINGTON, Nov. 2, 2016 /PRNewswire-USNewswire/ -- The Image Gently Alliance, American Academy of Pediatrics (AAP), American College of Emergency Physicians (ACEP), AANS/CNS Joint Section on Pediatric Neurosurgery and allied medical organizations have launched the "Think A-Head" campaign...

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